Knowledge Of Results Feedback Research Articles

Rehabilitation Treatment Specification System for Voice Therapy: Application to Everyday Clinical Care.

Rehabilitation intervention descriptions often do not explicitly identify active ingredients or how those ingredients lead to changes in patient functioning. The Rehabilitation Treatment Specification System (RTSS) provides guidance to identify the critical aspects of any rehabilitation therapy and supported the development of standardly named ingredients and targets in voice therapy (Rehabilitation Treatment Specification System for Voice Therapy [RTSS-Voice]). This study sought to test the content validity of the RTSS-Voice and determine if the RTSS-Voice can be used to identify commonalities and differences in treatment (criterion validity) across clinicians in everyday clinical practice. Five speech-language pathologists from different institutions videotaped one therapy session for 59 patients diagnosed with a voice or upper airway disorder. Specifications were created for each video, and iterative rounds of revisions were completed with the treating clinician and two RTSS experts until consensus was reached on each specification. All 59 sessions were specified without the addition of any targets or ingredients. There were two frequent targets: (a) increased volition and (b) decreased strained voice quality. There were three frequent ingredients: (a) information regarding the patient's capability and motivation to perform a therapeutic behavior, (b) knowledge of results feedback, and (c) opportunities to practice voicing with improved resonance and mean airflow. Across sessions treating vocal hyperfunction, there was large variability across clinicians regarding the types and number of treatment components introduced, types of feedback provided, and vocal practice within spontaneous speech and negative practice. The RTSS and the RTSS-Voice demonstrated strong content validity, as they comprehensively characterized 59 therapy sessions. They also demonstrated strong criterion validity, as commonalities and differences were identified in everyday voice therapy for vocal hyperfunction across multiple clinicians. Future work to translate RTSS principles and RTSS-Voice terms into clinical documentation can help to understand how clinician and patient variability impacts outcomes and bridge the research-practice gap. https://doi.org/10.23641/asha.24796875.

Exploring the Impact of Two Feedback Types on Speech Intelligibility, Precision, and Naturalness.

This pilot study examined the impact of feedback type on learning a novel speech task, as measured by listener ratings, and will inform procedures for future investigations within a larger sample size. Twenty-four native monolingual English-speaking college-aged adults participated in a single training session to learn novel Hindi phrases. Participants were randomly placed into one of three feedback groups: knowledge of performance (KP), knowledge of results (KR), or a combined KP + KR condition. Participant performance was assessed at 1 day and 1 week post-training. Participant responses were audio recorded and judged for intelligibility, precision, and naturalness by native Hindi speakers, blind to the feedback conditions, via rating scales. At 2 days post-training, participants in the KP and KP + KR feedback conditions were rated as performing better than participants in the KR condition on all three perceptual measures. At 1 week post-training, participants in the KP feedback condition were judged to be superior across all three perceptual measures. Preliminary findings suggest that augmented feedback enhances learning, especially when skills are considered novel and learners are unable to rely on their own internal feedback. These results may have implications for the application of motor learning principles into clinical practice for persons with motor speech disorders.

Computer-based knowledge of results feedback in different delivery modes: Effects on performance, motivation, and achievement emotions

Immediate Knowledge of Results (KR) feedback at the task level may motivate test takers by showing that their answers matter. Appealing feedback cues may help to prevent negative emotions in lower performers who receive a higher amount of negative feedback. In this experiment, we varied the presence of KR feedback and the feedback delivery mode in a 1 × 5 between-subjects design (i.e., no feedback vs. text, color, sound, or animation feedback) to investigate effects on learning outcomes and affective-motivational measures. Our sample included 661 fifth and sixth graders who solved two computer-based multiple-choice science tests. First, students worked on an 18-item treatment test (with experimental feedback manipulation). Students repeatedly rated their effort, enjoyment, pride, and boredom during the test, as well as their expectancy of success and attainment value after the test. Subsequently, they worked on a posttest (without feedback) that assessed recall and near-transfer learning. All KR feedback conditions significantly increased recall, but there was no evidence for near-transfer learning. Feedback had a significant, negative effect on attainment value, whereas significant interactions between the feedback conditions and students’ treatment performance revealed that feedback effects on several affective-motivational dimensions (i.e., expectancy of success, enjoyment, pride, and boredom) were performance-dependent. Feedback benefited higher performers’ motivation and affect but showed negative effects on some affective-motivational measures for lower performers. The pattern of results indicated that color/sound/animation feedback may have reduced the effect of performance on emotional feedback perception to some extent. However, none of the feedback conditions improved affective-motivational outcomes independent of students’ performance.

The influence of type of feedback during tablet-based delivery of intensive treatment for childhood apraxia of speech

PurposeOne of the key principles of motor learning supports using knowledge of results feedback (KR, i.e., whether a response was correct / incorrect only) during high intensity motor practice, rather than knowledge of performance (KP, i.e., whether and how a response was correct/incorrect). In the future, mobile technology equipped with automatic speech recognition (ASR) could provide KR feedback, enabling this practice to move outside the clinic, supplementing speech pathology sessions and reducing burden on already stretched speech-language pathology resources. Here, we employ a randomized controlled trial design to test the impact of KR vs KP feedback on children’s response to the Nuffield Dyspraxia Programme 3, delivered through an android tablet. At the time of testing, ASR was not feasible and so correctness of responses was decided by the treating clinician. MethodFourteen children with CAS, aged 4–10 years, participated in a parallel group design, matched for age and severity of CAS. Both groups attended a university clinic for 1-hr therapy sessions 4 days a week for 3 weeks. One group received high frequency feedback comprised of both KR and KP, in the style of traditional, face-to-face intensive intervention on all days. The other group received high frequency KR + KP feedback on 1 day per week and high frequency KR feedback on the other 3 days per week, simulating the service delivery model of one clinic session per week supported by tablet-based home practice. ResultsBoth groups had significantly improved speech outcomes at 4-months post-treatment. Post-hoc comparisons suggested that only the KP group showed a significant change from pre- to immediately post-treatment but the group difference had dissipated by 1-month post-treatment. Heterogeneity in response to intervention within the groups suggests that other factors, not measured here, may be having a substantive influence on response to intervention and feedback type. ConclusionMobile technology has the potential to increase motivation and engagement with therapy and to mitigate barriers associated with distance and access to speech pathology services. Further research is needed to explore the influence of type and frequency of feedback on motor learning, optimal timing for transitioning from KP to KR feedback, and how these parameters interact with task, child and context-related factors.

Knowledge of performance feedback among boys with ADHD

BackgroundChildren with attention deficit-hyperactivity disorder (ADHD) often experience delays in acquiring competence completing fundamental motor skills. The effects of augmented prescriptive knowledge of performance feedback (PKP) have not been explored as a possible component solution. AimsThe purpose of this study was to test the motor learning effects of KP among boys with ADHD. Methods and proceduresThirty-one boys with ADHD, randomly selected into either a treatment or a control group, completed a series of cornhole games. It was hypothesized that PKP feedback administered to treatment group participants would increase motor learning. Dependent variables included cornhole scores and quality of performance measures. Outcomes and resultsBoth groups improved in cornhole scores and improvement was not dependent upon KP. Treatment group participants performed significantly better in quality of performance of the underhand toss compared to the control group. Conclusions and implicationsPKP feedback improves motor skill performance learning among children with ADHD above knowledge of results feedback only. Recreational program directors should consider using KP feedback when teaching motor skills to boys with ADHD.

Effects of self-control and instructor-control feedback on motor learning in individuals with cerebral palsy

In this study we investigated the effects of "self-control and instructor-control feedback" on motor learning in individuals with cerebral palsy (CP). For this reason 22 boy students with CP type I (12.26±3.11 years of age) were chosen. They were put into self-control feedback, instructor-control feedback and control groups. All participants practiced dart throwing skill for 5 sessions (4 blocks of 5 trails each session). The self-control group received knowledge of results (KR) feedback for half of their trials whenever they wanted. The instructor-control group received KR feedback after half of both their good and bad trails. The control group received no feedback for any trails. The acquisition test was run immediately at the end of each practice session (the last block) and the retention and transfer tests were run 24h following the acquisition phase. Analyses of variance with repeated measures and Post hoc tests were used to analyze the data. According to the results of this study, individuals with CP have the ability of acquiring and retaining a new motor skill. Also, it was found that self-control feedback is effective than instructor-control feedback on learning of a motor task in individuals with CP as in the average population. These findings show that rules regarding feedback also apply to people afflicted with CP.

The Need and Benefit of Augmented Feedback on Service Speed in Tennis

Accurate knowledge of results (KR), in the form of service speed, is important in learning to serve faster. The aim was to determine whether players could accurately judge if their serve was faster or slower than their preceding serve (experiment 1) and if providing them with accurate augmented KR feedback on service speed using a speed gun could enhance learning after training (experiment 2). In experiment 1, 11 high-level national junior players served 10 serves to a target area and were asked to judge whether the serve was faster/slower that the preceding serve. In experiment 2, 12 high-level national junior players, divided into two groups, trained to improve their service speed for 12 wk (three sessions per week). During the first 6 wk (90 maximum-effort serves/session), they received either augmented (group 1) or no augmented (group 2) KR feedback. During the following 6 wk, participants did not complete the 90 serves per session and received no augmented KR feedback (retention test). In experiment 1, players could not correctly determine whether serves were faster/slower than the preceding serve. In experiment 2, both groups significantly enhanced their service speed after the initial 6 wk of service training, but the enhancement was significantly greater (P = 0.01) in the augmented versus no augmented KR feedback group (0.84 ± 0.38 vs 0.22 ± 0.04 m·s⁻¹ ). These enhancements were still evident during the retention test (P = 0.01). Players cannot accurately judge service speed, and by providing this information in the form of augmented feedback, a player can enhance the process of learning to serve faster with training. Players should therefore use augmented feedback on service speed when training to serve faster.

Motor Retraining in Virtual Reality: A Feasibility Study for Upper-Extremity Rehabilitation in Individuals With Chronic Stroke

Background and Purpose. Individuals with stroke can improve upper-extremity function in the chronic phase, providing rehabilitation is intensive, attended, and of sufficient duration. Virtual reality has been used in motor retraining; however, off-the-shelf game consoles may not be appropriate for those with marked motor impairment and high finger or arm spasticity. The objective of this study was to investigate the feasibility and effects of training in individuals with chronic stroke who are either high-functioning or low-functioning, and also spastic. Case Descriptions. Four volunteers, 3 men and 1 woman, were recruited from a local aphasia support group. All individuals were chronic post stroke with right-side hemiplegia. Training took place at the Tele-Rehabilitation Institute at Rutgers University. The intervention was performed on the Rutgers Arm II, a prototype training table that senses supported arm movement and grasp strength and tilts to resist or assist reach. Participants played games that adapted automatically to each individual's motor abilities. The games were practiced over 6 weeks, 3 sessions every week, with sessions lasting up to 1 hour. The 4 participants were evaluated by a senior physical therapist before, immediately following, and 6 weeks after the intervention. No occupational or physical therapist was present during the training sessions. Outcomes. The primary outcomes were changes in the affected upper-extremity subset of the Fugl-Meyer test and self-reported changes in the participants' activities of daily living. Improvements in active range of motion and grasp strength were secondary outcomes. All individuals improved in Fugl-Meyer scores and retained these gains (participant 1, 45 to 50; participant 2, 16 to 22; participant 3, 12 to 20; participant 4, 42 to 51). Participants 2 and 3, who presented with severe motor impairment, began using their affected arms in daily activities subsequent to training. All participants improved in their shoulder, elbow, and finger flexion active range of motion. Remarkably, participants 2 and 3, who were unable to exert force in grasping or pinching pre-training, could now do so and retained these gains at 6 weeks following the intervention. Well-being and mood seemed to improve in all participants. Discussion and Conclusion. Results show that motor retraining in virtual reality is feasible, well-tolerated by participants, and benefitting them. The Rutgers Arm II system was able to train participants, who varied greatly in their degree of motor impairment, but without a clinician being present. The present study contributes to the body of knowledge on novel virtual rehabilitation interventions for the upper extremity. Key Words: Upper extremity, Virtual reality, Sustained grasp, Rutgers Arm, Stroke. BACKGROUND AND PURPOSE The direct and indirect costs associated with head injuries from stroke or trauma approach $200 billion a year in the United States alone.1'2 At the completion of standard-of-care motor retraining (6 to 9 months post stroke), individuals present with varying levels of upper-extremity (UE) functional recovery. Their recovery depends not only on the type and severity of the initial injury to the central nervous system, but also on the intensity and length of rehabilitation subsequently provided. Diminished upper-extremity function in the chronic phase post stroke negatively affects the individual's degree of independence in activities of daily living (ADLs), mental health, and social life. The person's motivation to improve and the important role knowledge of results feedback plays in motor relearning3 both point to the need to investigate virtual reality as an element of therapy. Virtual worlds4 have been shown to provide rich knowledge of results and to increase motivation if tailored to the individual's abilities.5'6 Virtual reality previously has been investigated as a way to conduct motor rehabilitation following a stroke. …

Case-based learning with worked examples in complex domains: Two experimental studies in undergraduate medical education

To investigate the effects of example format (erroneous examples vs. correct examples) and feedback format (elaborated feedback vs. knowledge of results feedback) on medical students' diagnostic competence in the context of a web-based learning environment containing case-based worked examples, two studies with a 2 × 2 design were conducted in the laboratory. In the first study (domain: arterial hypertension; N = 153) erroneous examples were effective in combination with elaborated feedback with respect to strategic and conditional knowledge. In the second study (domain: hyperthyroidism, N = 124), elaborated feedback supported all aspects of diagnostic competence, especially conditional knowledge.

Guidance hypothesis with verbal feedback in learning a palpation skill

Objective To investigate whether a force application of a novel motor skill was simple or complex and to determine the appropriate level of feedback during training. The objective was to determine the effects of various amounts of knowledge of results (KR) on learning a novel skill that is frequently taught in chiropractic for the assessment of vertebral motor unit dysfunction. Methods Thirty-five active subjects were taught the novel skill of spring testing to a particular force range through 9 or 10 teaching sessions over a 2-week period (a school holiday limited some to only 9 sessions). To determine the particular force range, an initial phase of the study involved a licensed and practicing clinician performing motion palpation spring testing of the thoracic spine of a prone subject. The data from a total of 47 pushes throughout the thoracic spine were recorded, and the mean force and standard deviation were calculated. The second phase of the study used the obtained mean and standard deviation for teaching the force of prone thoracic spine motion palpation to 35 active subjects by administering spring testing to 35 passive subjects. The active subjects were randomly divided into 4 groups, with each receiving a varying amount of verbal feedback to move toward the target force of their learned skill. Each passive subject was laid prone on an instrumented adjusting table. Group 1 received the least amount of feedback while learning the novel skill. Groups 2 and 3 received more frequent, intermittent feedback while learning the skill, and group 4 received constant, frequent feedback during each of the 10 teaching sessions. All subjects returned within 2 weeks for 2 retention trials to determine the efficacy of the learned skill. Results The mean force determined was 143 N with a standard deviation of 14 N. Each subject was taught spring testing within this target range. The 2 final retention trials showed group 3 to have demonstrated the most targeted retention of the learned motor skill. These subjects exhibited the closest force range to the target for the motor skill learned and fewer changes in standard deviation compared with their acquisition trials and thus the highest retention. Group 4, receiving 100% feedback, demonstrated the most accurate spring testing during the acquisition trials, but the subjects did not effectively demonstrate when compared on acquisition and retention trials. Conclusion The results of this study show data to be consistent with the guidance hypothesis in learning a novel motor skill. The constant KR feedback is beneficial for learning when used to reduce error during practice but detrimental when relied upon for retention and learning. These data suggest the necessity of using motor skill development learning theory in the teaching of chiropractic.

Accuracy of movement speed and error detection skills in adolescents with cerebral palsy.

People with cerebral palsy (CP) usually have decreased ability to learn new movements and decreased movement speed. This study examined the ability of 10 adolescents with CP (M age = 16.2 yr., SD = 1.9 yr.) to achieve a target speed on an tipper extremity ballistic task and to detect speed errors in their movements, compared to the performance of 10 adolescents with no disability (M age = 15.7 yr., SD = 1.7 yr.). Subjects were instructed to slide a lever along a track in 150 msec., then guess their movement time. Knowledge of results feedback was provided on the first 50 trials except for Trials 11-20 on Day 1. Knowledge of results feedback was withheld on Day 2, Trials 51-60, to assess learning and retention of the skill. Speed Error and Error Detection were compared for two groups of adolescents on Trials 51-60. Independent t tests indicated a significant difference between the two groups for both Speed Error and Error Detection. Examination of individual scores of the adolescents with CP indicated that half scored within the range of the control group, and variability of skills within the group with CP was high. Some individuals with CP have deficits in accuracy of movement speed and error detection unrelated to their severity of CP which may affect their ability to learn new movements.

ACCURACY OF MOVEMENT SPEED AND ERROR DETECTION SKILLS IN ADOLESCENTS WITH CEREBRAL PALSY

People with cerebral palsy (CP) usually have decreased ability to learn new movements and decreased movement speed. This study examined the ability of 10 adolescents with CP (M age= 16.2 yr., SD = 1.9 yr.) to achieve a target speed on an upper extremity ballistic task and to detect speed errors in their movements, compared to the performance of 10 adolescents with no disability (M age=15.7 yr., SD = 1.7 yr.). Subjects were instructed to slide a lever along a track in 150 msec, then guess their movement time. Knowledge of results feedback was provided on the first 50 trials except for Trials 11–20 on Day 1. Knowledge of results feedback was withheld on Day 2, Trials 51–60, to assess learning and retention of the skill. Speed Error and Error Detection were compared for two groups of adolescents on Trials 51–60. Independent t tests indicated a significant difference between the two groups for both Speed Error and Error Detection. Examination of individual scores of the adolescents with CP indicated that half scored within the range of the control group, and variability of skills within the group with CP was high. Some individuals with CP have deficits in accuracy of movement speed and error detection unrelated to their severity of CP which may affect their ability to learn new movements.